Staying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outs

Laparoscopic cholecystectomy is one of the most common procedures in General Surgery. Devastating complications of laparoscopic cholecystectomy include vascular and bile duct injury. Bile duct injury is an especially serious and potentially life-threatening complication that occurs at a reported rate of 0.08–1.5% (1–4). Vasculobiliary injuries can be prevented by following an algorithmic approach to laparoscopic cholecystectomy. At our institution, we have devised a culture for safe laparoscopic cholecystectomy designed around two principles: landmarking and intraoperative time-outs to determine if it is safe to progress. This standardized approach and decision tree have been helpful in promoting safe completion of laparoscopic cholecystectomies even in the most challenging cases (5). We have disseminated this approach to safe laparoscopic cholecystectomy to several divisions of General Surgery in our region through educational rounds. The purpose of this manuscript is to describe our clinical pathway and highlight the art we have developed to illustrate the algorithmic approach. These educational materials may be valuable tools for the broader community of General Surgeons to promote a culture of safety for laparoscopic cholecystectomies.